CYSTITIS

Cystitis technically means inflammation of the bladder. In practice, the bladder and urethra are often both inflamed. Many cystitis symptoms are really caused by inflammation of the urethra (urethritis).

Bacterial cystitis

See Urinary tract infections

Non-bacterial cystitis/urethritis

Occurs in both men and women. Inflammation is triggered by physical or chemical damage, such as:

• bruising of the urethra by vigorous sexual intercourse or wearing very tight clothing
• antiseptics in bath water, perfumed soaps, vaginal deodorants or douches
• spermicidal creams
• changing a catheter.

Recurrent attacks suggest an unusually sensitive bladder and urethral lining. After the menopause, lack of oestrogen causes these linings to become thinned and more susceptible to infection or injury. Interstitial cystitis (IC) A chronic inflammation of the bladder wall, more common in women. Causes frequency of urination (up to 60 x a day) and severe pelvic pain

Urinary tract infections (UTIs)

A UTI is an infection of any part of the urinary tract, i.e.

• Kidneys and ureters (upper urinary tract)
• Bladder and urethra (lower urinary tract)

Urine is usually sterile (but asymptomatic bacteriuria occurs in 20% of women) and most UTIs arise from E. Coli which normally lives in the colon. UTIs are:

• More common (50x) in women than in men
• Less common in men but potentially more serious
• More common in the elderly

and can be classified as:

• Uncomplicated (normal urinary tract and function)
• Complicated (abnormal tract, male sex, impaired renal function, virulent organism, impaired host defences

UTI symptoms and signs

Lower UTI (cystitis, urethritis) can present with dysuria, frequency, urgency, haematuria. The urine can be cloudy with an unpleasant odour. In older people there may be generalised symptoms such as confusion and incontinence.

Upper UTI symptoms (pyelonephritis) are the same as lower UTI symptoms plus suprapubic pain or tenderness, pyrexia and possible rigors. The patient is likely to be ill and may need hospital admission.

Prostatitis may present with low backache, flu-like symptoms, urinary symptoms, swollen tender prostate.